Active NPI
Tiffany Graham
- Registered Nurse
- Winfield, WV
National Provider Identifier
1245953736
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 71148
- Practice address
- 18 Sylvester Dr
Winfield, WV 25213-9361 - Phone
- (304) 395-5085
- NPI assigned
- Sep 21, 2022
- Last updated
- Sep 21, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 71148 | WV | Primary |
Addresses
Primary practice location
18 Sylvester Dr
Winfield, WV 25213-9361
Mailing address
5187 US Route 60 Ste 13
Huntington, WV 25705-2076
Phone (304) 733-5010
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 163W00000X | Medicaid | WV |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | desktop/tablet |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 71148 | WV | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1663718400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1663718400000",
"number": "1245953736",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5187 US ROUTE 60 STE 13",
"city": "HUNTINGTON",
"state": "WV",
"postal_code": "257052076",
"telephone_number": "304-733-5010",
"fax_number": "304-733-5024"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18 SYLVESTER DR",
"city": "WINFIELD",
"state": "WV",
"postal_code": "252139361",
"telephone_number": "304-395-5085"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAHAM",
"first_name": "TIFFANY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-09-21",
"last_updated": "2022-09-21",
"certification_date": "2022-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "WV",
"license": "71148",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "163W00000X",
"state": "WV"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "desktop/tablet",
"affiliation": "N",
"address_1": "18 Sylvester Dr",
"city": "Winfield",
"state": "WV",
"country_code": "US",
"postal_code": "252139361",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Winfield, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.